Relational Liberty Revisited: Membership, Solidarity and a Public Health Ethics of Place

Abstract

moral commitment to support the application of general norms to the life situation of the Other as a creature with a certain moral status. It thereby embraces the common moral rules or principles (equal protection of the law; universal human rights) without more fully embracing the lived reality and distinct perspectives of the Other. Standing up with involves adopting a perspective that is more internal to the lifeworld and the contextually meaningful agency of the Other. Standing up as returns to generality, in the sense of a recognition of common humanity, a shared membership in the universal moral community, but also moves one imaginatively more deeply into a comprehension of the difference of the Other, the distinctive individuality of the Other, and it is on the basis of that difference that ties of membership and solidarity are established. Individuality is not the same as individualism. And difference is not free floating but rooted in historical, cultural and geographic location. Standingup-as solidarity is the solidarity of humanity in place, the solidarity of being embodied, vulnerable, located and locatable. As the moral recognition of the Other is altered by this interpretive journey, so is the moral imagination of the self. Strong bonds of attachment and identification and empathy may not be the destination of this journey. But arguably a growth in one’s capacity to project oneself imaginatively into the perspective and viewpoint of the other person, and a growth in moral awareness or the ability to see connections previously unseen are plausible outcomes of the interpretive transformation effected by the trajectory of solidarity. Need I add how integral these recognitions are to public health policy and practice and to being a supportive member or citizen of a public health regime, a commonwealth of population health and well-being? Moreover, the growth and development of the moral imagination inherent in the practice of solidarity comes about through its emplaced enactment. Standing up with, for and as are not stances taken anywhere or nowhere, they are located in a here and now. The where and when of them matter to their meaning, political efficacy and moral justification. This line of reflection shows, I think, that solidarity and place are symbiotic concepts and intertwined lived realities. Solidarity requires place, and place is normatively disfigured when it does not provide the ground for nurturing solidarity. A Normative Conception of Place In his novel, Immorality, Milan Kundera makes an intriguing distinction between a highway and a road: ‘A highway differs from a road . . .A highway has no meaning in itself; its meaning derives entirely from the two points that it connects. A road is a tribute to space. Every stretch of road has meaning in itself and invites us to stop’ (1992: 223). Quite a bit is going on in this deceptively causal remark. Kundera is suggesting a fundamental division in our consciousness of spatial and temporal location. This distinction marks two different modes of human artifice and cultural praxis. A highway is a space of utility only, defined by dimensions of transience and empty occupation. A road is a tribute to concrete, particular location, it inhabits and celebrates the place where it is, and thus a road can itself be a place in its own right. Highways are across spaces, while roads are of places. Highway space is abstract and geometrical, it is a zone in which the mind has no time to spare for meandering or sightseeing on its journey to some precisely specifiable point. Road place, on the other hand, is a winding path through a tangled bank; it is a location of side trips and unexpected turnings. What is significant about places is not so much their physical dimensions as their imaginative possibilities (Smith, 2001; Cresswell, 2004). They are not occupied, they are dwelt within by living things, and, through memory, myth and meaning, inanimate things can be alive in place as well. They are made such by the perceptions and sensibilities of everyone who lives a life somewhere, as opposed to anywhere. There are good places and bad places, we say. Of course, that is a straightforward way of putting it. But are the moral qualities of a place simply incidental or imposed from somewhere else—the philosopher’s view from nowhere, an impartial spectator standing with Archimedes on a platform outside the world, a divine perspective sub specie aeternitatis? Or is the goodness of a place constitutive and inherent, already in place, arising from its own ground? I say that a space of injustice and unfreedom is not a place at all as I understand the concept. I think it is appropriate to regard some configurations of human behavior and habitation as negations of place rather than as genuine places. It is indeed that aspect of them, which provides one reason, among others, for trying to change them and to prevent them from reemerging again in the future. Although there is an ineluctable normative component in the concept of place, there is also great emotional 8 JENNINGS by gest on Jauary 8, 2015 http://pherdjournals.org/ D ow nladed from resonance and power in place-making and place identification. Much like dignity, place is a vague and dangerous concept. Debased places of injustice, exclusion, denial of membership and voice and eclipse of solidarity can nonetheless elicit loyalty through idealized memory, nostalgia and the oppositional social imaginary of an Us rather than an inclusive imaginary of a We. Consequently, a misguided or misplaced sense of place can work against public health and health justice. We need to beware its reactionary potential. Not only is it impossible to comprehend a somewhere without also comprehending what a nowhere is; it is also impossible to understand how and why and to what end any place works without also understanding how and why some places do not. Public health is inherently involved in the normative activity of place-making for the sake of health. This is because health itself is emplaced. The health and wellbeing that public health seeks is a health that is lived in a here and now, not abstractly atomistic, not somehow free floating in time. If we think of health (and illness too) as made up of universal states or possibilities— health is health anywhere at any time—then we are adopting the medical model. If we think of health as also emplaced then we are seeing through the lens of a social, historical model of public health. As Hortensia Amaro has argued: Life opportunities, including a healthy life, are largely determined either directly or indirectly by the contextual qualities of where we live. The last three decades have produced a large and rich body of research documenting that where we live, grow, work and play determine not only life opportunities, but also determine risk of illness and individual actions taken to prevent or treat illness. . . .Now, research is needed to guide upstream approaches, including place-based interventions, which address contextual factors that shape major public health problems . . . (Amaro, 2014: 964). Neither in relationship with other subjects nor when using natural objects are human beings completely at liberty to do what they will. Relational liberty does not give us license to behave as if we were living in the moral equivalent of a frictionless surface, an atomized, nonrelational world of particles in motion, an abstract ‘space’, a nonor anti-place. The notions of a membership of recognition and respect and a solidarity of mutual care and concern denote the dimension of liberty that promotes a kind of moral (and political or civic) community and place that is open rather than closed, a hospitable community of participation, voice, reciprocity and care. The moral imagination of place is grounded on the idea that those who dwell in a somewhere sometime should have access to a place where each attains moral parity with fellow sufferers, fellow creatures of need and aspiration, fellow inhabitants of the body human and the body politic. If public health is not to overlook these crucial aspects of its own mission, public health ethics must recognize the ethics of place as a vital component of